Anthem, Inc. Provider Contract/Cost of Care Consultant in Middletown, New York
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Provides analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Works on large scale initiatives with high dollar cost savings opportunities. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead.
Primary duties may include, but are not limited to:
Performs varied data analyses which may include: developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs;
Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing pre-negotiation analyses to support development of defensible pricing strategies;
Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic;
Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
Provides Medicaid P&L, actuarial and enterprise financial support in the analysis of medical expenses, medical expense trend, membership, revenue, medical loss ratio and drill downs.
Provides Medicaid Business Units and leaders with analysis of revenue and medical costs on a restated basis and reconcile restated financial results to results reported in financial statements in prior periods – to help strengthen performance management.
Independently develops sound applications and models necessary to efficiently measure, understand, monitor and explain the company’s medical cost structure and restated financial results.
Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex models to create predictive impact decision making tools; performing healthcare cost analysis to identify strategies to control costs; projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing pre-negotiation analysis to support development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic; measuring and evaluating the cost impact of various negotiation; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projects different cost of savings targets based upon various analytics.
Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures.
Recommends policy changes and claim's system changes to pursue cost savings.
Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
Recommends standardized practices to optimize cost of care.
Educates provider contractors on contracting analytics from a financial impact perspective.
May recommend alternative contract language and may go on-site to provider premises during contract negotiations.
Participates on project team involved with enterprise wide initiatives.
Acts as a source of direction, training and guidance for less experienced staff.
Requires BS/BA degree in Mathematics, Statistics, Data Science, Finance or Economics related field;
5 years experience in broad-based analytical, managed care payor or provider environment;
Considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background.
Progressive data analysis and reporting experience.
Proficiency with Microsoft Excel
5 years of experience in managed healthcare analytics
Familiarity with claims data and authorization data experience
Advanced Excel knowledge.
PowerBI or Tableau
Master's degree Data Science.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.